“Know Safety, No Pain”: Exploring perceptions of nursing staff on Patient Safety in a mental health-care setting in Pakistan

Abstract

Objectives: In psychiatric wards, nursing staff plays a central role in handling unique patient safety issues due to their proximity and extended interaction with the patients. This qualitative exploratory study aims to understand the socio-cultural and institutional factors that act as opportunities and/or barriers to provision of patient safety in an in-patient psychiatric unit. Methods: Employing participant observation and critical incident technique that guided the semi-structured interviews, 23 nursing staff of a tertiary care hospital in Rawalpindi, Pakistan, were approached in their natural setting, that is, the wards or outpatient departments during the months of March–June 2021. Results: Using a-priori and emerging codes, six themes were revealed: “Socialization” of mental health, Role Conflict: Nurturing versus Controlling, Approaches: Proactive versus Reactive, Potential Risks to Patient Safety, Indigenous “Painless” procedures for physical restraint, Gender roles matter. The study discusses how the increasing awareness around mental health influences care decisions, how family members act as extensions to nursing role and how the nurses exhibit ambivalence toward the use of restraints. Conclusion: The study concludes that the conceptualization of nurses regarding mental health issues, patient safety, physical restraints, seclusion, cultural, and gender norms is also reflected in their care provision. Nurses’ autonomy, decision-making, cultural context, and training in clinical interventions are significant for patient safety in psychiatric nursing practice.